Provider Demographics
NPI:1144500893
Name:TIRITILLI, KIMBERLEE GAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:GAY
Last Name:TIRITILLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2618
Mailing Address - Country:US
Mailing Address - Phone:512-244-3008
Mailing Address - Fax:
Practice Address - Street 1:2021 W PECAN ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3528
Practice Address - Country:US
Practice Address - Phone:512-251-4554
Practice Address - Fax:512-251-5569
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist